Immune modulation by parenteral lipid emulsions
ABSTRACT Total parenteral nutrition is the final option for nutritional support of patients with severe intestinal failure. Lipid emulsions constitute the main source of fuel calories and fatty acids (FAs) in parenteral nutrition formulations. However, adverse effects on patient outcomes have been attributed to the use of lipids, mostly in relation to impaired immune defenses and altered inflammatory responses. Over the years, this issue has remained in the limelight, also because technical advances have provided no safeguard against the most daunting problems, ie, infectious complications. Nevertheless, numerous investigations have failed to produce a clear picture of the immunologic characteristics of the most commonly used soybean oil-derived lipid emulsions, although their high content of n-6 polyunsaturated FAs (PUFAs) has been considered a drawback because of their proinflammatory potential. This concern initiated the development of emulsions in which part of the n-6 FA component is replaced by less bioactive FAs, such as coconut oil (rich in medium-chain saturated FAs) or olive oil (rich in the n-9 monounsaturated FA oleic acid). Another approach has been to use fish oil (rich in n-3 PUFA), the FAs of which have biological activities different from those of n-6 PUFAs. Recent studies on the modulation of host defenses and inflammation by fish-oil emulsions have yielded consistent data, which indicate that these emulsions may provide a tool to beneficially alter the course of immune-mediated conditions. Although most of these lipids have not yet become available on the US market, this review synthesizes available information on immunologic characteristics of the different lipids that currently can be applied via parenteral nutrition support.
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ABSTRACT: Objective: Review the literature regarding parenteral nutrition of preterm infants in order to propose a practical guideline for indication, increase of parameters and monitor- ing of this nutritional therapy in neonatal units. Data source: Studies in English and Portuguese from the last ten years were retrieved from Medline, Embase, Lilacs and SciELO using the following key-words: preterm infants, parenteral nutrition, nutrition therapy and lipid emulsions. Also classical studies and consensus on the theme were manually searched. Data synthesis: Parenteral nutrition is an essential treatment strategy for preterm infants. Besides progress in knowledge and legislation, several factors contribute to reduce neonatal morbidity and mortality of newborns using parenteral nutrition and to increase the security in its prescription such as catheters' quality, training of the multiprofessional team and development of new specifi c parenteral nutrition formulations. Conclusions: The practical parenteral nutrition guide- line proposed here follows international guidelines and was based on critical analysis of the studies published in the last 10 years.
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ABSTRACT: Orthogonal experiments were employed to optimize the correlated parameters of reduction, sulfonation, substitution and hydrolysis. These reactions were used to convert γ-linolenic acids into dihomo-γ-linolenic acids (DGLA). For the reduction, the best reaction conditions were at 35°C for 4.5h with LiAlH4 and γ-linolenic acid (in the ratio of 40g:100g); for the sulfonation, reaction at 29°C for 3.5h with 150g γ-linolenic alcohol and 65mL mesyl chloride, then the water phase being extracted with dichloromethane (3×100mL); for the substitution, the reaction at 80°C for 2.5h with metallic sodium and sulfonate (at a ratio of 8g:100g); and for the hydrolysis, reaction at 80°C for 2.5h with NaOH and dihomo dioate (at a ratio of 50g:100g). The four reactions gave yields that exceeded 90% for each step. Finally, crystallization and decarboxylation provided DGLA in an overall yield of 60% and >95% purity.Journal of Oil & Fat Industries 01/2008; 86(1):77-82. DOI:10.1007/s11746-008-1320-0 · 1.62 Impact Factor
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ABSTRACT: Lipids and glucides, the energetic compounds in artificial nutrition solutions, are not only “fuel” but possess other biologic functions which may influence disease evolution. Energy-yielding solutions should cover the patient’s metabolic needs but should also limit any inflammatory and oxidative stress or impairment of the immune system. This paper provides a concise overview of the clinical and metabolic properties of the most common energetic substrates employed both in enteral and parenteral nutrition. KeywordsLipids-Glucides-Parenteral and enteral nutrition-Clinical effectsMediterranean Journal of Nutrition and Metabolism 04/2009; 3(1):9-14. DOI:10.1007/s12349-009-0064-1